Left ventricular free wall rupture following mitral valve replacement

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Ventricular Rupture Management

Background:

• Mitral valve replacement (MVR) is a common cardiac procedure.
• Left ventricular rupture is a rare but life-threatening complication following MVR.
• Understanding rupture types and effective management strategies is crucial for improving patient outcomes.

Observation:

• Over a decade, 110 patients underwent MVR, with three instances of left ventricular rupture.
• Ruptures included two immediate Type I and one delayed Type III.
• Two patients with Type I and Type III ruptures survived after surgical repair.

Findings:

• Successful bleeding control was achieved using manual compression with oxidized cellulose, collagen mat, and fibrin glue, with or without sutures.
• One patient with Type I rupture, treated with external sutures and a left ventricular assist device, unfortunately died from brain infarction.
• Supportive care, including intra-aortic balloon pump and sedation, aided ventricular unloading and reduced tension on repairs.

Implications:

• Manual compression techniques with biomaterials can be effective for minor lacerations and reinforcing repairs.
• Intra-aortic balloon pumps and sedation are valuable adjuncts for managing ventricular stress post-rupture repair.
• These findings highlight the importance of tailored surgical and supportive interventions for left ventricular rupture after MVR.